1
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Fowler XP, Krafcik B, Cai M, Gladders B, Spangler E, Moore KO, Wong S, Stone D, Soybel D, Columbo J, Goodney PP, Davies L. A Retrospective Analysis of Surgical Acuity & Procedure Volume Before & During the COVID-19 Pandemic. J Surg Res 2024; 296:696-703. [PMID: 38364697 DOI: 10.1016/j.jss.2023.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/09/2023] [Accepted: 11/12/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION In March 2020, the American College of Surgeons recommended postponing elective procedures amid the COVID-19 pandemic. We used Medicare claims to analyze changes in surgical and interventional procedure volumes from 2016 to 2021. METHODS We studied 37 common surgical and interventional procedures using 5% Medicare claims files from January 1, 2016, through December 31, 2021. Procedures were classified according to American College of Surgeons guidelines as low, intermediate, or high acuity, and counts were analyzed per calendar year quarter (Q1-Q4), with stratification by sex and race/ethnicity. RESULTS We observed 1,840,577 procedures and identified two periods of marked decline. In Q2 2020, overall procedure counts decreased by 32.2%, with larger declines in low (41.1%) and intermediate (30.8%) acuity procedures. High acuity procedures declined the least (18.2%). Overall volumes increased afterward but never returned to baseline. Another marked decline occurred in Q4 2021, with all acuity levels having declined to a similar extent (40.1%, 44.2%, and 46.9% for low, intermediate, and high acuity, respectively). High and intermediate acuity procedures declined more in Q4 2021 than Q2 2020 (P = 0.002). Similar patterns were observed across sex and race/ethnicity strata. CONCLUSIONS Two major procedural volume declines occurred between 2020 and 2022 during the COVID-19 pandemic in the United States. High acuity (life or limb threatening) procedures were least affected in the first decline (Q2 2020) but not spared in second decline (Q4 2021). Future efforts should prioritize preserving high-acuity access during times of stress.
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Affiliation(s)
- Xavier P Fowler
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont.
| | - Brianna Krafcik
- The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ming Cai
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont
| | - Barbara Gladders
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Emily Spangler
- Department of Surgery, Veterans Affairs Medical Center, Birmingham, Alabama
| | - Kayla O Moore
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Sandra Wong
- Department of General Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - David Stone
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Surgery, Veterans Affairs Medical Center, White River Junction, Vermont
| | - David Soybel
- Department of Surgery, Veterans Affairs Medical Center, White River Junction, Vermont
| | - Jesse Columbo
- The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Surgery, Veterans Affairs Medical Center, White River Junction, Vermont
| | - Philip P Goodney
- The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Surgery, Veterans Affairs Medical Center, White River Junction, Vermont
| | - Louise Davies
- The VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vermont; Department of Surgery, Veterans Affairs Medical Center, White River Junction, Vermont; The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Department of Surgery - Otolaryngology Head & Neck Surgery, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
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2
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Columbo JA, Scali ST, Neal D, Powell RJ, Sarosi G, Crippen C, Huber TS, Soybel D, Wong SL, Goodney PP, Upchurch GR, Stone DH. Increased Preoperative Stress Test Utilization is Not Associated With Reduced Adverse Cardiac Events in Current US Surgical Practice. Ann Surg 2023; 278:621-629. [PMID: 37317868 DOI: 10.1097/sla.0000000000005945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To measure the frequency of preoperative stress testing and its association with perioperative cardiac events. BACKGROUND There is persistent variation in preoperative stress testing across the United States. It remains unclear whether more testing is associated with reduced perioperative cardiac events. METHODS We used the Vizient Clinical Data Base to study patients who underwent 1 of 8 elective major surgical procedures (general, vascular, or oncologic) from 2015 to 2019. We grouped centers into quintiles by frequency of stress test use. We computed a modified revised cardiac risk index (mRCRI) score for included patients. Outcomes included in-hospital major adverse cardiac events (MACEs), myocardial infarction (MI), and cost, which we compared across quintiles of stress test use. RESULTS We identified 185,612 patients from 133 centers. The mean age was 61.7 (±14.2) years, 47.5% were female, and 79.4% were White. Stress testing was performed in 9.2% of patients undergoing surgery, and varied from 1.7% at lowest quintile centers, to 22.5% at highest quintile centers, despite similar mRCRI comorbidity scores (mRCRI>1: 15.0% vs 15.8%; P =0.068). In-hospital MACE was less frequent among lowest versus highest quintile centers (8.2% vs 9.4%; P <0.001) despite a 13-fold difference in stress test use. Event rates were similar for MI (0.5% vs 0.5%; P =0.737). Mean added cost for stress testing per 1000 patients who underwent surgery was $26,996 at lowest quintile centers versus $357,300 at highest quintile centers. CONCLUSIONS There is substantial variation in preoperative stress testing across the United States despite similar patient risk profiles. Increased testing was not associated with reduced perioperative MACE or MI. These data suggest that more selective stress testing may be an opportunity for cost savings through a reduction of unnecessary tests.
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Affiliation(s)
- Jesse A Columbo
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Veteran's Affairs Medical Center, White River Junction, VA
| | - Salvatore T Scali
- University of Florida, School of Medicine, Gainesville, FL
- Department of Surgery, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Dan Neal
- University of Florida, School of Medicine, Gainesville, FL
- Department of Surgery, University of Florida, Gainesville, FL
- Malcolm Randall Veterans Affairs Medical Center, Gainesville, FL
| | - Richard J Powell
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - George Sarosi
- University of Florida, School of Medicine, Gainesville, FL
- Department of Surgery, University of Florida, Gainesville, FL
| | - Cristina Crippen
- University of Florida, School of Medicine, Gainesville, FL
- Department of Surgery, University of Florida, Gainesville, FL
| | - Thomas S Huber
- University of Florida, School of Medicine, Gainesville, FL
- Department of Surgery, University of Florida, Gainesville, FL
| | - David Soybel
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Veteran's Affairs Medical Center, White River Junction, VA
| | - Sandra L Wong
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Philip P Goodney
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Veteran's Affairs Medical Center, White River Junction, VA
| | - Gilbert R Upchurch
- University of Florida, School of Medicine, Gainesville, FL
- Department of Surgery, University of Florida, Gainesville, FL
| | - David H Stone
- Geisel School of Medicine at Dartmouth, Hanover, NH
- Dartmouth-Hitchcock Medical Center, Lebanon, NH
- Veteran's Affairs Medical Center, White River Junction, VA
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3
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Carbaugh L, Montagnese B, Raja N, Tiersky R, Soybel D. Engaging the Poetic Perspective on Care of the Surgical Patient: Lessons from W.H. Auden's "Surgical Ward". J Surg Educ 2022; 79:8-10. [PMID: 34353765 DOI: 10.1016/j.jsurg.2021.06.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/23/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
Attention has been brought to the importance of cultivating empathy, communication skills, reflective writing, and self-care in surgeons-in-training. Classical literature and poetry pertaining to themes of surgery, specifically sonnets, can be exemplary methods for cultivating such skills. "Surgical Ward" by W.H. Auden is such a sonnet. Here we suggest that working poems such as "Surgical Ward" can cultivate transferable skills for analysis of text, context and subtext, as well as providing a substrate for discussion of multiple perspectives. These skills can aid in the development of surgical decision-making to produce positive outcomes, yet also benefit self-reflection when mistakes are inevitably made.
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Affiliation(s)
| | | | | | | | - David Soybel
- Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Surgical Service of the Veterans Affairs Medical Center, White River Junction, Vermont.
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4
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Ssentongo A, Ssentongo P, Keeney L, Ebenezer A, Amponsah-Manu F, Soybel D, Oh JS. Opportunistic Screening for Nonalcoholic Fatty Liver Disease (NAFLD) in Ghana: A Prospective Study. Curr Dev Nutr 2020. [DOI: 10.1093/cdn/nzaa053_114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Objectives
Non-alcoholic fatty liver disease (NAFLD) is a leading cause of cryptogenic cirrhosis and liver transplant in the United States. It is associated with increased length of stay and poor surgical outcomes. NAFLD affects approximately 30% of American adults, and even more Africans. However reported rates of NAFLD in African countries vary widely, where recent studies have shown that up to 50–87% Africans are could be living with NAFLD. The objective of this study was to estimate the prevalence of NAFLD in Ghana and to assess whether NAFLD is associated with increased length of stay and surgical complications.
Methods
A prospective study on 96 surgical patients aged 18 and older, without a history of alcohol abuse or liver disease, who presented at Eastern Reginal Hospital in Ghana for elective general and gynecological procedures between September and December 2018. A single, expert radiologist screened all patients for NAFLD using an abdominal ultrasound machine. NAFLD was diagnosed in conjunction with the American Association for the study of liver disease guidelines, assessing for increased hepatic echogenicity compared to the spleen and kidneys. Patients were followed up for 30 days and information was collected on length of stay and surgical site occurrences (SSO). Univariate analysis and multivariable logistic regression were performed using SAS 9.4.
Results
Of 97 patients, mean age 46 ± 14 years, mean BMI 26.9 ± 7.7, and 40 (42%) Male, the mean length of stay was 2.7 days ± 2.7 days. Eighteen (19%) patients had a length of stay ≥ 5 days and 9 (9%) developed a SSO. Ultrasonography revealed that 54 (56%) of patients had NAFLD, of which 15 (28%) patients had moderate disease (25–50% of liver), and 39 (72%) had mild (5–25%) disease. Diabetes, hypertension, obesity, and BMI were not associated with NAFLD. NAFLD and sex were independent predictors of an increased length of stay ≥ 5 days, where patients with NAFLD were 5x as likely to have an extended length of stay, but not SSO compared to those without NAFLD (OR: 4.8 95% CI 1.1–18.5).
Conclusions
Ghana has almost twice the prevalence of NAFLD compared to the United States, suggesting that NAFLD is very common in Africa. It is associated with delayed surgical recovery leading to more than twice the average length of stay.
Funding Sources
None.
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5
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Shen C, Gu D, Klein R, Zhou S, Shih YCT, Tracy T, Soybel D, Dillon P. Factors Associated With Hospital Decisions to Purchase Robotic Surgical Systems. MDM Policy Pract 2020; 5:2381468320904364. [PMID: 32072012 PMCID: PMC6997967 DOI: 10.1177/2381468320904364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 12/18/2019] [Indexed: 01/03/2023] Open
Abstract
Background. Robotic surgical systems are expensive to own and
operate, and the purchase of such technology is an important decision for
hospital administrators. Most prior literature focuses on the comparison of
clinical outcomes between robotic surgery and other laparoscopic or open
surgery. There is a knowledge gap about what drives hospitals’ decisions to
purchase robotic systems. Objective. To identify factors associated
with a hospital’s acquisition of advanced surgical systems. Method.
We used 2002 to 2011 data from the State of California Office of Statewide
Health Planning and Development to examine robotic surgical system purchase
decisions of 476 hospitals. We used a probit estimation allowing
heteroscedasticity in the error term including a set of two equations: one
binary response equation and one heteroscedasticity equation.
Results. During the study timeframe, there were 78 robotic
surgical systems purchased by hospitals in the sample. Controlling for hospital
characteristics such as number of available beds, teaching status, nonprofit
status, and patient mix, the probit estimation showed that market-level directly
relevant surgery volume in the previous year (excluding the hospital’s own
volume) had the largest impact. More specifically, hospitals in high volume
(>50,000 surgeries v. 0) markets were 12 percentage points more likely to
purchase robotic systems. We also found that hospitals in less competitive
markets (i.e., Herfindahl index above 2500) were 2 percentage points more likely
to purchase robotic systems. Limitations. This study has
limitations common to observational database studies. Certain characteristics
such as cultural factors cannot be accurately quantified.
Conclusions. Our findings imply that potential market demand is
a strong driver for hospital purchase of robotic surgical systems. Market
competition does not significantly increase the adoption of new expensive
surgical technologies.
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Affiliation(s)
- Chan Shen
- Department of Surgery, Division of Outcomes Research and Quality, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvani
| | - Dian Gu
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Roger Klein
- Department of Economics, Rutgers University, New Brunswick, New Jersey
| | - Shouhao Zhou
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvania
| | - Ya-Chen T Shih
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Thomas Tracy
- Department of Surgery, Division of Outcomes Research and Quality, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvani
| | - David Soybel
- Department of Surgery, Division of Outcomes Research and Quality, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvani
| | - Peter Dillon
- Department of Surgery, Division of Outcomes Research and Quality, The Pennsylvania State University, College of Medicine, Hershey, Pennsylvani
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Ssentongo A, Ssentongo P, Armen S, Soybel D, Oh J. Central Obesity Is a Predictor of Stress Hyperglycemia in Critically Ill Geriatric Trauma Patients (P21-051-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz041.p21-051-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
In the elderly population, hyperglycemia is associated with increased rates of infections, length of hospital stay (LOS) and mortality. However, there is a lack of informative studies addressing the drivers of hyperglycemia. We hypothesized that central obesity has an effect on hyperglycemia. Therefore, our objective is to investigate whether central obesity predicts hyperglycemia within the first 48 hours of admission in elderly trauma patients admitted to the ICU.
Methods
Our trauma registry was queried for all trauma patients aged 65 and older from 2012 to 2018 with an intensive care unit (ICU) LOS of at least 3 days. CT scan images were reviewed for visceral fat area, waist circumference to height ratio (WCHR), waist circumference to hip ratio (WHR) and the presence of sarcopenia, which has been implicated in adverse outcomes of trauma, in the presence or absence of obesity.
Results
Of 320 elderly patients, 7% developed infections, 3% developed stroke, 52% had an increased ICU LOS >6 days, and 48% had an increased total hospital LOS >14 d. The prevalence of sarcopenia was 26%, increased visceral fat area >200 cm2 was 87%, WCHR >0.65 was 25%, and WHR >1 was 54% All of these factors except sarcopenia were significant predictors of hyperglycemia >140 mg/dL (OR: 4.0, 95% CI: 2.53–6.46), (OR: 2.45, 95% CI: 1.47–4.16) and (OR: 3.1, 95% CI: 1.93–4.9) respectively. A total of 143 patients (45%) had an average glucose >140 mg/dL within the first 48 hours after admission and this was independently associated with infections (OR: 2.64, 95% CI: 1.06–7.13), stroke (OR: 5.88, 95% CI: 1.48–38.96), increased ICU LOS (OR: 1.87, 95% CI: 1.20–2.94) and increased hospital LOS (OR: 1.59, 95% CI: 1.02–2.48).
Conclusions
Central obesity independently predicts hyperglycemia in geriatric trauma patients. The influence of metabolic stressors related to adiposity may drive elevated glucose levels and could represent a novel target for future outcomes studies in geriatric critical illness
Funding Sources
None.
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Affiliation(s)
| | | | | | | | - John Oh
- Penn State University College of Medicine
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7
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Kaag M, Brunke-Reese D, Gogoj A, Lehman E, Soybel D. PD11-04 RECOVERY OF EXERCISE TOLERANCE AT THREE MONTHS FOLLOWING RADICAL CYSTECTOMY IN A PROSPECTIVE COHORT. J Urol 2018. [DOI: 10.1016/j.juro.2018.02.627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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8
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Lee S, Soybel D, Kelleher S. The Role of ZnT2 in the Mammary Gland during Lactation. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.121.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sooyeon Lee
- Cell and Molecular Physiology Penn State Hershey College of MedicineHersheyPAUnited States
- Nutritional SciencesPennsylvania State UniversityUniversity ParkPAUnited States
| | - David Soybel
- Cell and Molecular Physiology Penn State Hershey College of MedicineHersheyPAUnited States
- SurgeryPenn State Hershey College of MedicineHersheyPAUnited States
| | - Shannon Kelleher
- Cell and Molecular Physiology Penn State Hershey College of MedicineHersheyPAUnited States
- SurgeryPenn State Hershey College of MedicineHersheyPAUnited States
- Nutritional SciencesPennsylvania State UniversityUniversity ParkPAUnited States
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9
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Crowell K, Navaratnarajah M, Kelleher S, Soybel D, Lang C. Mild Zinc Deficiency Augments Increased TNF‐α Expression But Not Decreased Muscle Protein Synthesis after Acute Sepsis. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.122.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kristen Crowell
- Department of SurgeryPenn State Hershey Medical CenterHersheyPennsylvaniaUnited States
| | | | - Shannon Kelleher
- Cell. & Molec. Physiology Penn State College of MedicineHersheyPennsylvaniaUnited States
| | - David Soybel
- Department of SurgeryPenn State Hershey Medical CenterHersheyPennsylvaniaUnited States
- Cell. & Molec. Physiology Penn State College of MedicineHersheyPennsylvaniaUnited States
| | - Charles Lang
- Cell. & Molec. Physiology Penn State College of MedicineHersheyPennsylvaniaUnited States
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10
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Chandler P, Kochupurakkal B, Lopez V, Alam S, Soybel D, Kelleher S. The Zinc Transporting Network is a Central Component of Dysregulation in Breast Cancer. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.921.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paige Chandler
- Cell and Molecular Physiology The Pennsylvania State UniversityUnited States
| | | | | | - Samina Alam
- Cell and Molecular Physiology The Pennsylvania State UniversityUnited States
| | - David Soybel
- Cell and Molecular Physiology The Pennsylvania State UniversityUnited States
- SurgeryThe Pennsylvania State UniversityUnited States
| | - Shannon Kelleher
- Cell and Molecular Physiology The Pennsylvania State UniversityUnited States
- SurgeryThe Pennsylvania State UniversityUnited States
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Podany A, Geletzke A, Lee S, Soybel D, Kelleher S. The Zinc Transporter ZnT2 is Necessary for Stabilization of Granule Contents in Intestinal Paneth Cell Granules. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.1011.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Sooyeon Lee
- Cell & Molecular PhysiologyPenn State HMCHersheyPAUnited States
- Nutritional SciencesPenn State State CollegePAUnited States
| | - David Soybel
- SurgeryPenn State HMCHersheyPAUnited States
- Cell & Molecular PhysiologyPenn State HMCHersheyPAUnited States
| | - Shannon Kelleher
- SurgeryPenn State HMCHersheyPAUnited States
- Cell & Molecular PhysiologyPenn State HMCHersheyPAUnited States
- PharmacologyPenn State HMCHersheyPAUnited States
- Nutritional SciencesPenn State State CollegePAUnited States
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12
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Mack R, Bostanci Z, Alam S, Lee S, Soybel D, Kelleher S. Marginal zinc intake impairs mammary gland involution, increases oxidative stress and disrupts ductal integrity abrogating the protective effect of lactation on breast tumorigenesis in a mouse model (1043.3). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.1043.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ronald Mack
- KinesiologyPennsylvania State UniversityUniversity ParkPAUnited States
- Nutritional SciencesPennsylvania State UniversityUniversity ParkPAUnited States
| | - Zeynep Bostanci
- SurgeryPenn State Hershey College of MedicineHersheyPAUnited States
- Nutritional SciencesPennsylvania State UniversityUniversity ParkPAUnited States
| | - Samina Alam
- SurgeryPenn State Hershey College of MedicineHersheyPAUnited States
- Nutritional SciencesPennsylvania State UniversityUniversity ParkPAUnited States
| | - Sooyeon Lee
- Nutritional SciencesPennsylvania State UniversityUniversity ParkPAUnited States
| | - David Soybel
- Cell and Molecular PhysiologyPenn State Hershey College of MedicineHersheyPAUnited States
- SurgeryPenn State Hershey College of MedicineHersheyPAUnited States
- Nutritional SciencesPennsylvania State UniversityUniversity ParkPAUnited States
| | - Shannon Kelleher
- Cell and Molecular PhysiologyPenn State Hershey College of MedicineHersheyPAUnited States
- SurgeryPenn State Hershey College of MedicineHersheyPAUnited States
- Nutritional SciencesPennsylvania State UniversityUniversity ParkPAUnited States
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13
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Kelleher S, Hennigar S, Soybel D, Alam S. Genetic variation in SLC30A2 (ZnT2): associations with mammary cell function and milk zinc concentration in breastfeeding women (893.41). FASEB J 2014. [DOI: 10.1096/fasebj.28.1_supplement.893.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Shannon Kelleher
- Department of Cell and Molecular Physiology Penn State Hershey College of MedicineHersheyPAUnited States
- Department of Surgery Penn State Hershey College of MedicineHersheyPAUnited States
- Department of Nutritional Sciences Penn State UniversityUniversity ParkPAUnited States
| | - Stephen Hennigar
- Department of Nutritional Sciences Penn State UniversityUniversity ParkPAUnited States
| | - David Soybel
- Department of Cell and Molecular Physiology Penn State Hershey College of MedicineHersheyPAUnited States
- Department of Surgery Penn State Hershey College of MedicineHersheyPAUnited States
- Department of Nutritional Sciences Penn State UniversityUniversity ParkPAUnited States
| | - Samina Alam
- Department of Surgery Penn State Hershey College of MedicineHersheyPAUnited States
- Department of Nutritional Sciences Penn State UniversityUniversity ParkPAUnited States
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14
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Itagaki K, Menconi M, Antoniu B, Zhang Q, Gonnella P, Soybel D, Hauser C, Hasselgren PO. Dexamethasone stimulates store-operated calcium entry and protein degradation in cultured L6 myotubes through a phospholipase A(2)-dependent mechanism. Am J Physiol Cell Physiol 2010; 298:C1127-39. [PMID: 20107037 DOI: 10.1152/ajpcell.00309.2009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Muscle wasting in various catabolic conditions is at least in part regulated by glucocorticoids. Increased calcium levels have been reported in atrophying muscle. Mechanisms regulating calcium homeostasis in muscle wasting, in particular the role of glucocorticoids, are poorly understood. Here we tested the hypothesis that glucocorticoids increase intracellular calcium concentrations in skeletal muscle and stimulate store-operated calcium entry (SOCE) and that these effects of glucocorticoids may at least in part be responsible for glucocorticoid-induced protein degradation. Treatment of cultured myotubes with dexamethasone, a frequently used in vitro model of muscle wasting, resulted in increased intracellular calcium concentrations determined by fura-2 AM fluorescence measurements. When SOCE was measured by using calcium "add-back" to muscle cells after depletion of intracellular calcium stores, results showed that SOCE was increased 15-25% by dexamethasone and that this response to dexamethasone was inhibited by the store-operated calcium channel blocker BTP2. Dexamethasone treatment stimulated the activity of calcium-independent phospholipase A(2) (iPLA(2)), and dexamethasone-induced increase in SOCE was reduced by the iPLA(2) inhibitor bromoenol lactone (BEL). In additional experiments, treatment of myotubes with the store-operated calcium channel inhibitor gadolinium ion or BEL reduced dexamethasone-induced increase in protein degradation. Taken together, the results suggest that glucocorticoids increase calcium concentrations in myocytes and stimulate iPLA(2)-dependent SOCE and that glucocorticoid-induced muscle protein degradation may at least in part be regulated by increased iPLA(2) activity, SOCE, and cellular calcium levels.
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Affiliation(s)
- Kiyoshi Itagaki
- Dept. of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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15
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Liu J, Mathew J, Kohler J, Blass A, Soybel D. Uptake of Zn2+ across the basolateral membrane of the gastric parietal cell is regulated by [Ca2+]i. FASEB J 2008. [DOI: 10.1096/fasebj.22.1_supplement.939.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Affiliation(s)
- Helena O B Taylor
- Department of Surgery, Brigham & Women's Hospital, Boston, Massachusetts, USA
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Matros E, Rocha F, Zinner M, Wang J, Ashley S, Breen E, Soybel D, Shoji B, Burgess A, Bleday R, Kuntz R, Whang E. Does Gum Chewing Ameliorate Postoperative Ileus? Results of a Prospective, Randomized, Placebo-Controlled Trial. J Am Coll Surg 2006; 202:773-8. [PMID: 16648017 DOI: 10.1016/j.jamcollsurg.2006.02.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Revised: 01/31/2006] [Accepted: 02/06/2006] [Indexed: 01/11/2023]
Abstract
BACKGROUND A preliminary report has been interpreted to suggest that gum chewing reduces duration of postcolectomy ileus. STUDY DESIGN We rigorously tested this hypothesis in a prospective, randomized, placebo-controlled study. Patients undergoing open colectomy (n = 66) were randomized to receive 1 of 3 postoperative regimens beginning on postoperative day 1: sips (control, n = 21); sips and accupressure wrist bracelet (placebo, n = 23); and sips and gum chewing (treatment, n = 22). Patients were unaware of which regimen constituted placebo or treatment; end points were assessed by blinded investigators. Power was set a priori at 85% to detect a 0.75-day difference in time to first postoperative passage of flatus between placebo and treatment groups. Groups were compared using the log-rank test. RESULTS Groups were equivalent with respect to demographic and surgical characteristics. Median times to first postoperative passage of flatus were as follows: sips, 67 hours; bracelet and sips, 72 hours; gum and sips, 60 hours (p = 0.384). There were no significant differences in time to passage of first bowel movement, time until patients were ready for discharge, or time until actual discharge among the three groups. Inpatient and 30-day followup demonstrated no difference in frequency or distribution of postoperative complications. CONCLUSIONS In contrast to findings of a preliminary study, our clinical trial suggests that gum chewing, although safe, does not reduce duration of postcolectomy ileus.
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Affiliation(s)
- Evan Matros
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Wieland AM, McKay B, Dubach MJ, Soybel D. Monochloramine, a gastrointestinal-specific reactive oxygen-nitrogen species, inhibits caspase-3 activation in isolated gastric glands of the rabbit. J Am Coll Surg 2004. [DOI: 10.1016/j.jamcollsurg.2004.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Khuri SF, Daley J, Henderson W, Hur K, Hossain M, Soybel D, Kizer KW, Aust JB, Bell RH, Chong V, Demakis J, Fabri PJ, Gibbs JO, Grover F, Hammermeister K, McDonald G, Passaro E, Phillips L, Scamman F, Spencer J, Stremple JF. Relation of surgical volume to outcome in eight common operations: results from the VA National Surgical Quality Improvement Program. Ann Surg 1999; 230:414-29; discussion 429-32. [PMID: 10493488 PMCID: PMC1420886 DOI: 10.1097/00000658-199909000-00014] [Citation(s) in RCA: 207] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity. SUMMARY BACKGROUND DATA In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes. Literature data to support this assumption in intermediate-complexity operations are either limited or controversial. METHODS The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used. Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA). RESULTS Eight major surgical procedures (68,631 operations) were analyzed. No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. CONCLUSIONS In VHA hospitals, the procedure and surgical specialty volume in eight prevalent operations of intermediate complexity are not associated with risk-adjusted 30-day mortality rate from these operations, or with the risk-adjusted 30-day stroke rate from CEA. Volume of surgery in these operations should not be used as a surrogate for quality of surgical care.
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Affiliation(s)
- S F Khuri
- Brockton/West Roxbury VA Medical Center, MA 02132, USA
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Affiliation(s)
- D Narayan
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
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Soybel D, Jaspan J, Polonsky K, Goldberg I, Rayfield E, Tager H. Differential immunoreactivity of plasma glucagon components in man: studies with different glucagon antibodies. J Clin Endocrinol Metab 1983; 56:612-8. [PMID: 6185527 DOI: 10.1210/jcem-56-3-612] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
To evaluate the relationship between glucagon antibody antigenic determinants and selective reactivity with plasma void volume (Vo) and lower molecular weight immunoreactive glucagon (IRG) components, we studied plasma IRG levels and molecular profiles in normal subjects and patients with disturbances in plasma glucagon levels using three glucagon antibodies, 30K and P7 raised against the whole peptide and antibody X4 raised against the C-terminal tryptic fragment of glucagon. In normal subjects and pancreatectomized patients, plasma IRG levels were 2- to 3-fold higher with the C-terminus-directed antibody X4 than with either 30K or P7, but in glucagonoma and uremic patients, this discrepancy was smaller. Gel filtration analysis revealed that these antibodies reacted identically with 3500 mol wt IRG and 9000 mol wt IRG in normal, glucagonoma, pancreatectomized, and uremic plasma. Relative immunoreactivity of Vo IRG was approximately 5:2:1 with antibodies X4, 30K, and P7, respectively. In two subjects with unexplained hyperglucagonemia, recovery of IRG was entirely in the Vo, with antiserum X4 reacting one third as well as 30K and P7 not reacting at all. Furthermore, this material did not dilute out in parallel to glucagon standard. These data indicate differential immunoreactivity of the high molecular weight circulating IRG component, with a series of three glucagon antibodies reacting similarly with all other plasma IRG fractions, and suggest that Vo IRG material in plasma is predominantly the result of an immunologically cross-reacting peptide sequence in a plasma protein. The selective immunoreactivity of this component with different antibodies has important implications for the glucagon RIA and may have some bearing on other immunoassays as well.
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Soybel D, Morgan J, Cohen L. Calcium augmentation of enzyme leakage from mouse skeletal muscle and its possible site of action. Res Commun Chem Pathol Pharmacol 1978; 20:317-29. [PMID: 674818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Creatine kinase efflux from isolated mouse skeletal muscle was monitored in the presence of various concentrations of Ca2+ or La3+ over a 5 hour period. Ca2+ levels between 10(-3) and 10(-2)M augmented enzyme leakage to greater than 300% above control. La3+, which is said to displace Ca2+ from sarcolemmal and t-tubule membranes, depressed enzyme efflux at concentrations between 10(-5) and 10(-3M. These data indicate that extracellular Ca2+ mediates in vitro enzyme efflux, and may be acting on the sarcolemma and its extensions. These observations may prove useful in developing new means to regulate enzyme leakage in various muscle disorders.
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